Bipolar disorder is an illness in which there are extreme changes or swings in mood.

Everyone has times in their life when they feel very happy (such as when you are
about to go on holiday) or very sad (such as when your pet dies). But it only becomes
a disorder when the mood changes are unusual or extreme. This can range from being
unusually happy (known as mania or hypomania), to being unusually sad (depression)
for no apparent cause.

What causes it?

Although the causes are not fully understood, bipolar disorder tends to run in families.
In people who have bipolar disorder, episodes may happen at times of stress or disrupted
sleep.

How common is it?

Bipolar disorder is extremely rare in young children, but there are quite a few studies
that suggest that it may start in teenage years and in early adult life. It affects
about 1 in 100 adults.

What are the symptoms?

In bipolar disorder a person can have:

Manic or hypomanic periods (or ‘episodes’) also known as ‘highs’

Depressive periods (or episodes) also known as ‘lows’

Mixed periods (or episodes) when symptoms of both ‘highs’ and ‘lows’ happen at the
same time

There are different types of this disorder depending on how severe the symptoms are
or how long they last.

The mood changes can sometimes happen very rapidly within hours or days (sometimes
called rapid cycling). For some people, the mood symptoms are less severe (sometimes
called ‘cyclothymia’).

In between the highs and lows, there are usually ‘normal’ periods that can last for
weeks or months. However, for some people, especially when they have had the disorder
from some time, these periods of ‘normalcy’ can be shorter.

Below is a list of the sort of symptoms that can occur in each type of episode. You
need to have at least one manic or hypomanic episode to be diagnosed with bipolar
disorder.

You need to have several symptoms at the same time for at least several days. If
there is just one symptom, then it is unlikely to be bipolar disorder.

Symptoms that can occur during a ‘high’ or manic episode:

Feeling incredibly happy or 'high' in mood, or very excited

Feeling irritable

Talking too much - increased talkativeness

Racing thoughts

Increased activity and restlessness

Difficulty in concentrating, constant changes in plans

Over confidence and inflated ideas about yourself or your abilities

Decreased need for sleep

Not looking after yourself

Increased sociability or over-familiarity

Increased sexual energy

Overspending of money or other types of reckless or extreme behaviour

Hypomania is a milder form of mania (less severe and for shorter periods). During
these periods people can feel very productive and creative and so see these experiences
as positive and valuable.

However, hypomania, if left untreated, can become more severe, and may be followed
by an episode of depression. At the extreme end, some people also develop something
called ‘psychosis'.

Symptoms that can occur during a depressive episode

Feeling very sad most of the time

Decreased energy and activity

Not being able to enjoy things you normally like doing

Lack of appetite

Disturbed sleep

Thoughts of self-harm or suicide

On the milder end, you may just feel sad and gloomy all the time. Here too, at the
extreme end, some people can develop psychosis.

Symptoms that can occur during a mixed episode

A mixture of manic symptoms and depressive symptoms at the same time

What effects can bipolar disorder have?

The exaggerated thoughts, feelings and behaviours can affect many aspects of life
and can lead to, for example:

Loss of confidence

Loss of sense of control a person feels over their life

Poor concentration which affects academic performance

Problems with relationships with family and friends

Behaviour that could place your health or life at risk, like drinking alcohol or
using drugs

How is it treated?

In the short term, depending on whether you are high or low and how severe it is,
you may need different treatments.

When you have severe symptoms, you may need medications and also sometimes admission
to hospital to help your symptoms and also keep you safe.

In the long term, the goal of treatment is to help you have a healthy, balanced and
productive life. This would include understanding the condition, controlling the
symptoms and preventing the illness from coming back.

Below we briefly describe each aspect of the treatment.

Help with understanding yourself and the illness (psychoeducation)

It is very important that you and your family are helped to understand bipolar disorder,
how best to cope and what to do to reduce the chances of it coming back. You and
your family may notice ‘triggers’ to your episodes and / or early warning signs that
an episode is starting. Being aware of these can help reduce the chance of episodes
occurring and getting help in the earliest stages of an episode can stop it from
getting worse.

Talking treatments (also known as ‘psychological therapies’)

These may include different types of therapies like:

Cognitive-Behavioural Therapy (CBT)

The young person, sometimes with their family, learns to understand the links between
their feelings and thoughts and how this affects their behaviour.

Family-focused treatment (Family Therapy)

The whole family can be helped to reduce stress, solve problems and communicate better.

Medication

Medication plays an important role in the treatment of bipolar disorder, especially
if episodes are severe.

The choice of medication can depend upon the type of episode (manic or depressed).
Everyone is different, and so the type of medication that is recommended will also
be different.

Medications can have mild or even severe side-effects. Your psychiatrist will be
able to advise about what they are and about what can be done to help. The risk of
side-effects needs to be balanced against the risk of the damaging effects of the
illness on a person's life.

Antipsychotic medications are usually used for high / manic episodes, while antidepressant
medications are used for the low / depressive episodes. You may also need medications
called mood stabilizers (e.g. lithium) which help to keep your mood stable both during
and between episodes.

It is important that medications are not taken only when the problems are serious.
If you have had more than one severe episode of illness, staying on medication is
important to reduce the risk of further episodes. Medication may be needed for months
or even years. Some people may, under medical supervision, be able to stop their
medication when they have recovered and have felt well for a while.

You may need physical examination and tests (like blood test) before starting or
while you are on medication. It is important that if you are prescribed medication,
you are regularly seen by your doctor or psychiatrist.

How long will I have the illness?

The high or low episodes can last from a few weeks to months. It is important to
recognise that you are not alone and to keep up hope. Some people only have one or
two episodes. For others the highs and lows can occur through their adult life. When
this happens, it is important that you learn to live with it and manage it.

What can I do?

The first step is recognising that something is different or a problem. Other people
are likely to have noticed that you seem different from your usual self, particularly
those who live with you

Speak to people who know you well, such as family and friends

Seeking medical advice early on is very important. If the bipolar illness can be
identified and treated quickly, this reduces its harmful effects

If you already have a diagnosis, understand your illness and problems. This can help
you to take control and get help before it gets more difficult. This can mean steps
like planning for a crisis and making choices about your career

Do things which help you to have a good health, like having a balanced healthy diet,
doing some exercise, and getting a good night’s sleep

Try to identify what makes you feel ‘stressed’ and identify ways of dealing with
it

How do I get help?

You may need to see your GP to talk about your concerns. They can then refer you
to your local Child and Adolescent Mental Health Service (CAMHS) who can offer more
specialist help.

If you have a school counsellor / nurse or learning mentor, they can also be a useful
person to talk to and may also be able to refer you to the local Child and Adolescent
Mental Health Services.